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Monday, January 23, 2012

Learning hand anatomy is important for any medical student. Despite being a relatively small area, the hand contains many structures which leads to many disease patterns. For example, ulnar nerve injuries can cause patterns of findings like Pope's blessing. However, by learning the hand systematically, these diseases can be eventually mastered.

As far as what order to learn hand anatomy, it makes sense to start with the bones as they form the framework which all the other structures course through or attach to. The long bones of the forearm that articulate with the wrist (also called the carpus) are the radius and the ulna, which are on the lateral and medial sides of the forearm, respectively. There are two rows of carpal bones, which will be discussed in further detail below. The distal row articulates with the metacarpals, which are named by the digit they attach to. The metacarpals, in turn, articulate with the proximal phalanges (single: phalanx), which join with the middle and distal phalanges to form the rest of the digits. Note, there is no middle phalanx in the first digit (the thumb).

Now about those carpal bones! Starting with the proximal row, there are the scaphoid, lunate, triquetrum, and pisiform. The distal row contains the trapezium, trapezoid, capitate, and hamate. How does anyone go about remembering them?

Simple! Mnemonics - the most common one being Some Lovers Try Positions That They Cannot Handle:

Some - Scaphoid

Lovers - Lunate

Try - Triquetrum

Positions - Pisiform

That - Trapezium

They - Trapezoid

Cannot - Capitate

Handle - Hamate

Keep in mind that the first four letters refer to the proximal row, and the second four to the distal row, both from radial/lateral to ulnar/medial side. Like every mnemonic, this one has a downside: there are THREE bones that start with 'T', two of which sound very similar to each other. How does one remember which T goes with which T bone?

For triquetrum, remember that the word in the mnemonic try sounds the same as the first syllable tri-.

Remember that, and there are only two T bones left, but they are spelled very similarly. No worries just remember that for trapezium, remember that the bone nearest the THUMB ends in -UM (say it aloud if that is unclear).

The remaining T bone has to be trapezoid.

Hopefully bearing that extra information along with the mnemonic will help you easily master the bones of the wrist. Since we're talking about the bone, here are some extra factoids to keep in mind:

The scaphoid is the most commonly fractured bone in the wrist.

Also, the scaphoid has retrograde perfusion, so if there is vascular insufficiency, avascular necrosis will go in a proximal to distal, unlike every other bone.

The lunate is the most commonly disLocated bone in the wrist. On a lateral film, it looks like a half moon (hence, the name, as luna is Latin for moon).

Once you've mastered the bones, learning the muscles, nerves, arteries and veins becomes much more straightforward. Knowing the bones is also key for learning all the eponymous fractures that occur at or near the wrist (Boxer's fracture, Bennett's fracture, Rolando's fracture, Colles fracture, Smith fracture, etc.). It takes some amount of practice and repetition, but I have no doubt you can handle it =)

What is the Kindle Fire? It is Amazon's $199 color 7-inch tablet that runs Amazon's custom version of Android for tablets. Why does this matter for medical students? Here are a few reasons why the Fire does matter:

Price - At under $200, the tablet is much more affordable than the iPad for most medical students on a budget.

Portability - At 7", the tablet is light and small enough to carry to any lecture hall, or even on wards potentially.

Color - Unlike prior Kindles, the full color screen lets students get the most out of any medical resources they find online.

Amazon - Yes, the company selling the tablet matters. Given the huge amount of content Amazon offers and the proven track record of the Kindle family, students who buy the Kindle will not get left behind, unlike, say, buyers of HP's TouchPad, who shelled out 3x as much money just to find out less than 2 months later that HP was killing the product.

Price, again - Hello, you can buy three of these for the cost of an iPad.

All that being said, the Kindle Fire is not an automatic slam dunk. Some users find the 7" screen cramped for web browsing and that the browser is slow compared to the iPad's. Also, if you are interested in using apps that only run on iOS, they cannot be used on a Kindle Fire. Even some common Android apps may not function perfectly given Amazon's tweaks to the OS.

So, where does this leave a medical student? Basically right now, first ask yourself whether you really need a tablet and what role it would play in your education. Are the text books you like to read available in e-book versions? Do you heavily use online resources? Is your campus fully Wifi-enabled? If so, a tablet makes sense. But which one? If you have the budget, certainly test drive an iPad 2. However, if your budget is a little tighter, the Kindle Fire seems to be a fitting alternative. Although, for what it's worth, the best bet may just be to wait a little while for the Kindle Fire 2!

Monday, January 09, 2012

Being in-house overnight call is a rite of passage for all medical students and residents. From sleeping on old uncomfortable beds to being awoken in the night for scutwork, being on call can be miserable. However, there are somethings you can do to make your call more bearable. Having done a fair share of call, I've put together a list of items that you should pack in your bag whenever you're on call. Some are practical, some make your life more comfortable and some are absolutely necessary. Hope you find this list helpfulMust-Brings

1. Hospital ID / Access Card - Granted you should be wearing your identification normally, having a hospital ID when you're on call is a must. At night, many hospitals doors are locked and need special keycards to access. During the day, you may be able to get by without one but at night, be sure to bring it with you always.

2. Pager - As much as I hate this device, it is a must carry at night. It is often the only way someone can find you in the hospital. Worse, if you have unanswered pages from ward nurses or other health personnel, it can be considered unprofessional and have consequences.

3. Cellphone - if you're in a place with no wired telephones, a cellphone is crucial for returning pages. Similarly, lots of students, residents and staff communicate via text or direct calls to their personal phones. Also having a smartphone to look up medication dosages and references is handy.

4. Food / Snacks - It's important to take care of yourself and address your basic needs when on call. Bring a healthy dinner. Have lots of small snacks just in case you're up all night. Managing your energy levels is important for surviving busy call nights.

Useful to Bring

5.. Pocket Handbook - Whether it's a medication guide like Tarascon's or Pocket Medicine, having a quick reference can keep you out of trouble especially when you're not certain as to what's going on with a patient.

6. Money (Cash) - Most hospital cafeterias close early in the evening. You may want to grab some food from a vending machine or delivery to get you through the night. It's always helpful to have coffee money for your post-call morning.

7. Phone Charger - Most smartphones these days need to be charged daily. Nothing more inconvenient than having your phone die on you the next morning. 8. Toothbrush/Toothpaste/Floss - Going to sleep with poor oral hygiene feels terrible. Similarly, nobody likes a presenter with bad breath. Brushing your teeth in the morning is refreshing, and is a quick thing you can do to not feel gross in the morning. 9. Study Notes / Books - Some nights on call are not as busy as others. There is often some downtime if all the wards are quiet. Since you're in the hospital already, you might as well make the most of your time. Catch up on some of your studying while you're in the hospital, so you won't have to when you're post-call. If you still haven't taken Step 1, 2, or 3, bringing the relevant edition of First Aid can be quite useful. Bring a leisurely read if you want to have a bit of respite too.

10. Sleep wear - Lots of times call rooms can be quite cold - be sure to bring some warm clothing. Fleece jackets tend to be popular. Similarly, if you don't like sleeping in scrubs, real pajamas can make sleeping in the hospital a bit more bearable.

11. Comfortable Shoes - Running to the emergency room at 3am in heels or nice dress shoes is less than ideal. Bring comfortable runners like Dansko or Crocs clogs, something you're not afraid to get dirty, and something easy to slip into.

12. Alarm Clock - You can use your pager or phone to double as an alarm clock. If you would prefer being awoken by a more pleasant sound, a small travel sized alarm clock can do the trick.

13. White Coat - Some people find the extra pockets and warmth of a white coat useful. Try not to overload your whitecoat with too many tools, pens and books. Save some strain on your neck and only carry what is necessary and nothing more.

Final TipsLeave your valuables at home - jewelry, laptops, important documents. Pack only what is necessary and have a secure place to store your belongings. You are often the only one looking out for yourself when you're on call, so come prepared. Stay warm, remember to eat, rest when you can and your call nights will not be as stressful. Good luck on your next call shift!

Medaholic blogs about his journey through the Canadian medical system and offers advice for people at all stages of medical training at www.medaholic.com.

Monday, January 02, 2012

Happy new year! Last year was a difficult one for Scrub Notes - life got busy and challenging, and posting became infrequent. However, with a new year, we have a new plan to keep Scrub Notes active and useful for all our readers. Have any comments? Suggestions for topics you want addressed? Guest post? Let us know by contacting Scrub Notes today!

As we closed out 2011, we reviewed Atul Gawande's book 'The Checklist Manifesto' and how it could apply to medical students. After posting the review, this video clip of Gawande discussing his book and the Obama healthcare reforms was brought to our attention. The content is a little dated, but still interesting to listen to. Check it out!

Gawande is eloquent as usual, but he somewhat dodges some of Rose's questions. For example, when Rose asks what kind of system would be ideal in Gawande's mind, he simply avoids answering the hypothetical by noting its lack of basis in reality. However, that's the point: Rose wants to establish a baseline set of goals that a system should aspire to, even if it is not feasible in reality. Check it out, and let us know your opinion!